Treating Geographic Tongue
The dietary history and using the assumption that maximum requirements of protein and energy for hospitalized patients are 1.5g kg 14h and 40 kcal kg 24 h, respectively. Body composition studies suggest that when the 'finger-thumb test' (feeling the dermis between finger and thumb when pinching triceps and biceps skinfolds) is positive, the body mass is composed of 30 of body protein stores. However a standard clinical history and examination will also identify loss of muscle power, peripheral oedema, skin rashes, angular stomatitis, gingivitis, nail abnormalities, glossitis, paraesthesia and neuropathy.
Apart from the ruddy complexion, specific head and neck manifestations are unusual. Epistaxis in addition to bleeding from other sites may occur in up to 40 of patients. Pyoderma gangrenosum is reported to occur with the MPD. This is a necrotizing skin ulceration that occurs most commonly on the limbs of patients with inflammatory bowel disease. It can also occur on the face. Manifestations of iron deficiency may include glossitis and cheilosis.
Melkersson-Rosenthal syndrome is characterized by a triad of recurrent episodes of facial paralysis and facial edema along with a fissured tongue. Other neurologic sequelae have been documented, including headache, trigeminal neuralgia, cranial nerve dysfunction, and autonomic dysfunction. Although the etiology is unknown, recent investigation points toward a granulomatous disease leading to recurrent attacks of edema and inflammation of the face and oral cavity with a predilection for facial nerve involvement. Facial nerve involvement may be unilateral or bilateral, with varying frequencies of attacks and progression. No confirmatory blood test, histopathology, or radiographic evaluation is available, as the diagnosis is entirely clinical.
Megaloblastic anemia is usually a disease of middle-aged to older age with a high predilection for women. Severe anemia, in which the hemoglobin drops to 7 to 8 g dL, is accompanied by symptoms of anemias such as shortness of breath, light-headedness, extreme weakness, and pallor. Patients may experience glossitis (sore or enlarged tongue), dyspepsia, or diarrhea. Evidence of neurological involvement may be seen with patients experiencing numbness, vibratory loss (paresthesias), difficulties in balance and walking, and personality changes. Vitamin B12 deficiency causes a demyeliniza-tion of the peripheral nerves, the spinal column, and the brain, which can cause many of the more severe neurological symptoms such as spasticity or paranoia. Jaundice may be seen, because the average red cell life span in megaloblastic anemia is 75 days, a little more than one half of the average red cell life span of 120 days. The bilirubin level is elevated, and the lactate dehydrogenase (LDH) level is...
Lichen planus, hyperplastic candidiasis, geographic tongue, and certain genodermatoses. Of note, OHL is not associated with progression to malignancy, despite the well-known oncogenic association of EBV with other malignancies (Burkitt's lymphoma, nasopharyngeal carcinoma, and others).
Frequently all three forms coexist and the term multifocal candidiasis is used to describe the lesions. Candida is also frequently responsible for inflammatory lesions found between the lips (angular cheilitis), under dentures (denture stomatitis), and on the dorsal surface of the tongue (median rhomboid glossitis). Symptoms associated with this infection are pain, burning mouth, and dysphagia, which can lead to poor nutrition and significant patient morbidity (Fotos and Hellstein, 1992).
NME is the hallmark finding in glucagonoma syndrome. It is characterized by a polymorphous eruption that most commonly presents as scaly, erythematous papules and plaques with superficial erosions. The lesions typically are in a perioral distribution on the face (Fig. 9), but also involve the perineum, lower abdomen, thighs, buttocks, and less commonly the distal extremities. NME has been reported to be the presenting complaint in approximately two-thirds of patients with this tumor, but there are only rare cases of glucagonoma without NME ever occurring. Stomatitis, glossitis, dystrophic nails, and alopecia can also be seen. The eruption is frequently misdiagnosed as seborrheic dermatitis or intertrigo and can also resemble pemphigus foliaceus, acrodermatitis enteropathica, chronic mucocutaneous candidiasis, or psoriasis.
This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source Photo courtesy of Bruce Barker, DDS. FIGURE 45 Atrophic candidiasis. This 67-year-old female with a fissured tongue complained of a two-month history of a painful, sensitive, red tongue. There is mild atrophy of the lingual papillae. Fungal culture was positive for candidal organisms. Her symptoms cleared and appearance of her tongue returned to her normal fissured appearance with the use of clo-trimazole troches. Source Photo courtesy of Bruce Barker, DDS. FIGURE 46 Central papillary atrophy. Also referred to as median rhomboid glossitis, this was long believed to be a developmental condition. It is now...
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